BUSINESSNews in brief - March 24/31, 2008Tenn. Blues delays doctor rankings - Cigna chooses examiner in N.Y. - Aetna pays $6.6 million in refunds in Maine Tenn. Blues delays doctor rankingsBased on concerns by physicians, BlueCross BlueShield of Tennessee has postponed a planned physician rating program. On March 4, the Tennessee Medical Assn. alerted its members to the delay, after a Feb. 28 letter to the Blues plan requesting that the plan put off its rollout of the program. The association had requested that the company give physicians more time to review their ratings and that it reconsider using claims data to set quality ratings. No new customer rollout date has been set, said Blue Cross spokesman Scott Wilson. "It will probably be a matter of months, not weeks," he said. "We are working through what the program will be -- something that benefits our customers and that doctors think is fair." In letters to physicians, the plan had said the rankings would be based on doctors' performance of eight basic screening tests, whether a physician is board certified and costs of specific procedures. The quality data would have been derived from information in claims, and cost data would have come from the company's contracts with physicians. Cigna chooses examiner in N.Y.The National Committee for Quality Assurance will act as ratings examiner for Cigna as part of the company's agreement with New York Attorney General Andrew Cuomo to create a transparent and accurate quality ranking system for its network physicians, the company announced in February. Cigna, based in Bloomfield, Conn., was the first large health plan in the U.S. to sign a deal with Cuomo's office to create an independently evaluated performance rating program. The agreement to modify its Cigna Care Network tiering was announced on Oct. 29, 2007. Under the agreement, Cigna will pay for NCQA's periodic evaluation of Cigna's ranking program. The deal calls for the examiner to report to the attorney general's office every six months about how the Cigna program is working and whether the program complies with the agreement. NCQA is a nonprofit organization in Washington, D.C., that publishes the Healthcare Effectiveness Data and Information Set (HEDIS), a widely used performance measurement tool for health care quality evaluation. Aetna pays $6.6 million in refunds in MaineAbout 1,000 small groups insured through Aetna's PPO plan in Maine received premium refunds as a result of state insurance reforms adopted in 2003. The plan paid the groups a total of $6.6 million in refunds, which varied in size depending on the length of time the groups had been enrolled with Aetna and the amount of premiums they had paid, company spokeswoman Susan Millerick said. The Maine law establishing the subsidized insurance program Dirigo Health also set standards for how much of a company's income from premiums had to be used to pay claims. Aetna's PPO plan failed to meet the 78% minimum premium to be spent on claims between July 1, 2004, and June 30, 2007, prompting the refund, the state said. Millerick said the event was an anomaly that was in part due to the company's having two separate entities in business in Maine, one that operated its PPO, and the other its POS and HMO plans. Copyright 2008 American Medical Association. All rights reserved. |
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